Safe patient handling (SPH) is important not only for the patient’s safety but for the health care worker’s safety as well. The Registered Nurse (RN) is exposed daily to awkward body posture positions during patient handling and as a result sustains work-related musculoskeletal back injuries. Annually, 12% of the RN workforce will sustain a career ending back injury and leave the profession. It is reported by the American Nursing Association in 2011 that 8 of 10 RNs work despite musculoskeletal pain and 13% report being injured three or more times a year. RNs indicate that one of their top three safety concerns is suffering from a disabling musculoskeletal injury (Letourneau, 2014).Occupational safety and health is a major concern for any employer. Currently, overexertion injury rates for United States hospital workers are twice the national average compared to all other industries. On average, 76 of every 10,000 hospital workers will sustain a musculoskeletal injury (MSI) due to repetitive manual lifting, moving, and repositioning of patients (CDC, 2015). The alarming rates of injuries among the health care workers has led to extensive research and the enactment of laws requiring the use of safe patient handling programs in the health care setting. Evidence-based practice has shown that safe patient handling interventions can significantly reduce overexertion musculoskeletal injuries by replacing manual patient lifting with safer methods (CDC, 2015). To date, there are eleven states in the United States that have legislation requiring employers to implement a policy to protect their health care workforce. The state of California passed Assembly Bill No. 1136 in 2011, which requires an employer to maintain a safe patient handling policy (Swanson, 2011).
Methods:
The implementation of a SPH policy alone is not enough to effect change in the deep rooted nursing culture concerning safety. Now that the state of California requires all acute inpatient hospitals to maintain and enforce a SPH policy, the first identified problem is the way in which to educate all patient care staff. Two literature reviews were conducted to target RN unit peer leaders as the driving forces behind education and the sustainability of a new culture of safety for safe patient handling and identify conceptual frameworks that allow for a change in culture. The literature is in agreement that instituting a peer leader for safe patient handling is effective in reducing the rate of musculoskeletal injuries. They have also been identified as being the driving force for awareness and sustainability of the SPH program (Powell-Cope, 2014).
The second problem is finding a way to hold the RN workforce accountable for maintaining the hospital’s “No Lift” policy. Measuring and evaluating this change will occur slowly over time and the loss of visibility for a hospital’s SPH program can be a factor in its success. Two words that tend to get confused are responsibility and accountability. Responsibility is related to having a duty and accountability is related to justifying ones actions. For a nurse to fulfill the duties of their job, they must be responsible for their patients and themselves while being accountable to their peers and management. This accountability is the area in which a trained peer leader can be useful. One difficulty that has been documented is the culturally ingrained reluctance of peers to correct each other (Leistikow, 2011). The evidence gathered supports the implementation and education of unit peer leaders to assist with continued awareness of safe patient handling programs.
Because the age of the RN workforce is extremely diverse, it is important to find an educational conceptual framework that covers the entire workforce. The age of an RN can range from as young as 20 years old to the United States most senior RN at 90 years old in 2015 (CNN, 2015). In 2013, it was reported by The National Council of State Boards of Nursing and The Forum of State Nursing Workforce Centers that the average age of an RN is 50 years old. The conceptual framework that will be used to develop the safe patient handling unit peer leader education program is Malcom Knowles Adult Learning Theory (1984). This theory is a practical educational guide that accommodates all ages, but mainly focuses on adults. Knowles refers to andragogy (the practice of helping adults learn) as the foundation to his theory. When comparing this theory to traditional didactic, teacher-centered, learning, the Adult Learning Theory focuses on collaboration and problem solving as the core elements of the theory. Knowles identifies five major characteristics of the adult learner and describes the process by which adults learn (Knowles, 1984).
Coupled with Malcolm Knowles’ Adult Learning Theory, Kurt Lewin’s 1947 Change Theory will be utilized to develop the educational program for unit peer leaders to guide the change in culture. The Change Theory will help unit peer leader to focus on identification of forces promoting and forces resisting change (Lewin, 1947). Mobilizing nurses to change their culture of safety will take trained leaders to manage the change on a daily basis. The change will evolve over time as the old way of doing safe patient handling is unfrozen, remodeled and moved towards the new desired culture of safety, and finally refrozen and adopted (Burnes, 2013). This process will take planning, implementation, evaluation, and most importantly an educational program for unit peer leaders.
SPH unit peer leader education will consist of five educational in-service sessions. The education will be divided into knowledge based seminars and hands on training seminars. The first knowledge based seminar will be a PowerPoint presentation along with small peer social groups focusing on defining SPH terms and the role of the SPH Unit Peer Leader. As a specially trained hospital employee, the unit peer leader will be a role model in conducting patient lifts, transfers, and repositioning using lifting equipment. This seminar will give the unit peer leaders a foundational understanding to build on. The second knowledge base training seminar will be another PowerPoint presentation focusing on the CA SPH law, hospital policy, and culture change. The importance of understanding injuries related to safe patient handling will be covered as well. The third training seminar will be both knowledge based and hands. Focusing on the both verbal description and kinesthetic training of all hospital safe patient handling equipment. This safe patient handling equipment is defined as any assistive device that can be used to safely transfer patients while upholding the hospitals “no” lift policy. The forth training seminar will focus on how to conduct refresher training for all patient care staff. This seminar will be hands on with a peer to peer teaching component. One of the roles identified in the first seminar is that the unit peer leader will perform refresher training for all patient care staff on their respective units. The fifth and final training seminar is both a PowerPoint presentation as well as peer to peer practice of the patient mobility needs assessment. This tool is to be used by RN’s at the bedside to quickly assess their patient’s mobility so that the correct SPH equipment is utilized to mobilize their patients.
Results:
Once the research was completed and the educational seminars were created, the education was taken to a 480 bed urban university hospital and implemented for 8 months starting July 2015. Data was collected on the impact of the education on health care worker injures and cost of injuries from March 2015 to July 2016. The evidence showed that with the implementation of and education program focused on educating nursing unit peer leaders in safe patient handling, culture may be affected resulting in fewer injuries as well as less severe injuries saving not only the hospital money but the health care workers career by preventing the more serious injuries.
During the first 4 month period of the study, pre-implementation, data showed a total of 20 injuries were recorded resulting in $ 386,095 in organizational costs. During the first 4 months of implementation of the program, the data collected showed 6 injuries were recorded with organizational costs of only $16,897. During the second 4 months of implementation, the data collected showed 21 injuries were recorded with organizational costs of only $70,450. Finally, during the last 4 months of the study, post-implementation, the data collected showed 19 injuries were recorded with organizational cost of $206,779. The data for fiscal years 2015 (pre-implementation) and 2016 (post-implementation) total cost of SPH injuries shows that there was a total cost saving of $214,175 (Stanford Health Care, 2016).
Conclusion:
The conclusion drawn was that although the number of injuries during the post-implementation time period occurred at the same rate as they did during pre-implementation, the costs were considerably lower because less severe injuries were incurred. This shows that SPH education is effective in reducing severity of injures and overall organizational costs.Data may also been affected by but not limited to: effects of implementing new equipment, availability of Lift Coaches, new position of Program Manager of SPH, and visibility of the SPH program.